Nuclear medicine

The researches find that the Carbon 11-choline positron emission tomography/computed tomography (11C-choline PET/CT) and subsequent local therapy for oligometastatic prostate cancer have been report to be effective; but their efectiveness in castration resistant prostate cancer (CRPC) remains unclear. Here, we evaluated the findings of 11C-choline PET/CT in CRPC patients and the efcacy of local treatments in correspondence of the pathologic choline uptake.

11C-choline PET/CT

collected 12 cases of CRPC patients who underwent 11C-choline PET/CT between 2014 and 2016. The outcomes assesse included age, the prostate-specific antigen (PSA) value, the findings of 11C-choline; the subsequent treatments, the PSA response following the treatments, and the progression-free survival (PFS). progression despite initial androgen deprivation therapy and represents an unfavorable prognosis.

The outcome has signifcantly improved in recent years, through the addition of abiraterone, enzalutamide and cabazitaxel to the docetaxel, but remains reserved. In the same period; several prospective or retrospective studies of local treatments to primary tumor  or metastatic lesions  for oligometastatic prostate cancer with surgery or radiotherapy are publish; demonstrating positive outcomes; delaying the progression of the disease.

Oligometastatic prostate cancer

However, CRPC patients are usually exclude from these studies with few exceptions. One retrospective cohort study assessed the role of radiotherapy for node-negative; localized CRPC diagnosed by imaging modalities other than choline positron emission tomography/computed tomography (PET/CT). Radiotherapy was found to achieve excellent local control; however, it seemed to have a limited role in prolonging overall survival because most patients experienced progression with distant metastasis.

Another case series showed that radiotherapy improve local control and was associated with a significant prostate-specific antigen (PSA) response. Radiolabeled choline has been reported to be a useful modality for evaluating prostate cancer patients. Numerous retrospective studies and one meta-analysis have clarifed the high accuracy of choline PET/CT in the detection of lymph node metastases and/or distant lesions

Radiolabeled choline PET/CT

In patients with PSA relapse after radical therapy for prostate cancer. Several studies found that choline was more sensitive and specific than magnetic resonance imaging in the identification of nodal involvement; and more sensitive and specif than bone scan and contrast-enhanced CT in initial staging phase. Choline;and subsequent salvage lymph node dissection or external-beam radiotherapy in correspondence of the pathologic choline uptake for recurrent prostate cancer
has been report to be effective and well tolerate.

Several studies have assessed the response to systemic therapies of CRPC detected by choline PET/CT. However, there is only a case report describing the treatment of CRPC by choline PET/CT-guided palliative local treatment. Thus, the role of choline PET/CT in CRPC and choline -guided local treatments remains unclear